MAUREEN H. HINDS, BCCE, AAHCC
Birth, Babies & Beyond
Phone (408) 297-BABY ~ Beeper (408) 381-2217
CONTRACT
As your Professional Labor Assistant, I see my job as to facilitate the
process by which the woman (couple) takes responsibility for her (their) own
birth experience. My fees and services
will be as stated in the following contract.
My "On Call" fee is $400 and is due when services are
secured. The "On Call" fee is
also considered your deposit, and is non-refundable. Your due date will be secured with me when
the deposit is received; for my sanity & my family's benefit, it is my
policy to only book 1-2 births a month.
This deposit will guarantee my availability to perform these services
within, but not limited to, 1 week prior and 2 weeks after stated due date,
unless dates of unavailability have been discussed, agreed upon and noted in
the contract prior to the contract being made.
This also means that I pledge to you, baring unforeseen emergencies, to
not ever be more than 90 minutes away during this time.
The "Birth" fee is on a sliding scale from $550 - $1150.
As my client, I leave it up to you as to what within the scale you will
pay for the actual birth. Some things I
encourage you to consider in your decision are:
Your financial situation, the duration of the birth, your satisfaction
with the services rendered, etc. This
fee is due at the postpartum visit.
For these fees you will receive certain services, however, it should be
noted that my services in no way guarantees the medical outcome of this
birth.
The services included with the "On Call" fee include, but are
not limited to:
24
hour phone contact and consultation during pregnancy, early labor and
postpartum.
2
Prenatal visits - * if time allows
Visit #1: Its purpose is to acquaint
me on how to get to you home if I haven't been there before and to do an
initial interview to determine your expectations of me and my expectations of
you. We will also begin discussing
options for birth and your birth plan.
Often, the initial interview doubles as this visit. We will discuss and determine together if
another visit is necessary.
Visit #2: Its purpose is to go
over your final draft of the birth plan and to finalize arrangements such as
when you will be expecting me to arrive, what foods should available for mother
and attendants and where other necessary items are located for laboring at
home. If there are others attending the
birth, it would be extremely helpful to have them present at this meeting as
well. It is very important that all
involved be aware of what you expect from each and every participant in your
birth. I also request at this visit a
map to your planned place of birth from your home (if you are not birthing at
home), as well as an alternate map to the closest hospital (if it's not your
planned place of birth), in case of an emergency.
I would also be happy to attend a prenatal visit with you to your
careprovider appointment if they would like to meet with me.
The fee for the birth itself will include, but not
be limited to the following services:
Labor support for the birth itself - Jobs I will be performing at each
birth besides supporting the laboring mother will include but not be limited
to: making or getting meals, managing
birth related laundry, preparing/retrieving ice chips, drinks & food,
fielding phone calls, preparing/retrieving towels, massaging father's
shoulders, assisting father, photographing/video taping, using various natural
pain relief techniques, supporting your birthing choices, acting as liaison
between medical attendants and laboring couple, keeping visitors to a minimum
(and only those authorized by the couple to enter), informing the family of
progress of birth process, etc.
In the event of a marathon labor (labor lasting more than 24 hours) I
reserve the right to call in my labor assistant for temporary relief if needed
at an additional cost of $25.00/hr, paid directly to the relief assistant. After a short rest, I will resume my primary
role as your labor assistant. This is
for your safety and mine so that I can perform at my optimum for the
birth.
A
stay of approximately 1-2 hours postpartum to see that breastfeeding is off to
a good start and you are recovering well
1
Postpartum Visit:
This visit will usually be made in the first week following the arrival
of your new baby. Its purpose is to
check on breastfeeding progress and determine if mom is getting enough rest and
baby is doing well. If you are having
specific difficulties, I usually can arrange to come as soon as you need to see
me.
Fees are final and may not be refunded unless I, Maureen Hinds, default
on the contract.
In the event I am unable to attend a birth due to illness or other act
of God, the couple will be attended by the following backup assistant:
Michelle Germain, BCCE (408) 448-0320, Beeper # (408) 552-9453
MISCELLANEOUS
I do _______ or do not ________ want Maureen to video my
birth. If I do want her to make a video,
I agree to provide her with an 8mm videotape for use. If you wish, Maureen will copy the tape onto
VHS format. You will receive both the
copy and the original back. I will not
make copies of the tape for my own or anyone else's use.
I would ________ would not
_______ like Maureen to take still
pictures with our camera.
I would ________ would not
________ like the use of one of Maureen's births stools. If you would, please circle which one:
DeBy Stool (approximately 2' tall)
or Small Squat Stool
(approximately 12")
I have received, read & agree with the Doula Information &
Guidelines.
On Call Fee Deposit
Amount Paid
$________________ by
___________ date__________
We understand that, as an assistant, Maureen Hinds, is not trained in
any medical specialty and is providing only the service of support,
encouragement and supplemental education.
We understand that, in order to have the birth that we desire, we must
be willing to participate fully in education, prenatal meetings and
communication exercises as recommended.
We accept full responsibility for the decisions that are made on behalf
of ourselves and our child and recognize that a variety of unforeseen
circumstances could arise which could preclude our ability to have the delivery
and outcome that we desire and we realize that these events are out of the
control of our birth assistant.
This contract is drawn up and agreed to by the following persons as
designated by their signatures below:
____________________________________________ Date:__________
Maureen H. Hinds, BCCE, Professional Labor Assistant
_______________________________________
(please print names here) Mother
_______________________________________
Father/Coach/Partner
_______________________________________ Date:__________
(Signatures) Mother
_______________________________________ Date:__________
Father/Coach/Partner
Estimated Due Date:_________________